Healthcare Provider Details

I. General information

NPI: 1134078751
Provider Name (Legal Business Name): 9163 LLC
Entity Type: Organization
Gender:
Sole Proprietor:

II. Dates (important events)

Enumeration Date: 01/26/2026
Last Update Date: 01/26/2026
Certification Date: 01/26/2026
Deactivation Date:
Reactivation Date:

III. Provider practice location address

4080 N BLACKSTONE AVE
FRESNO CA
93726-3805
US

IV. Provider business mailing address

4721 W JENNIFER AVE STE 11
FRESNO CA
93722-6499
US

V. Phone/Fax

Practice location:
  • Phone: 559-270-5813
  • Fax:
Mailing address:
  • Phone: 559-270-5813
  • Fax:

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyY
Taxonomy Code177F00000X
TaxonomyLodging Provider
License Number
License Number StateNULL
# 2
Primary TaxonomyN
Taxonomy Code174200000X
TaxonomyMeals Provider
License Number
License Number StateNULL

VIII. Authorized Official

Name: MR. JATIN PATEL
Title or Position: CHIEF OPERATING OFFICER
Credential: BA
Phone: 559-270-5813